Speaker 1: Welcome to Stuff You Missed in History Class, a production
Speaker 1: of iHeartRadio.
Speaker 2: Hello, and welcome to the podcast. I'm Tracy V.
Speaker 1: Wilson, and I'm Holly Frye.
Speaker 2: I am kind of riffing on Holly's beloved theme of
Speaker 2: eponymous foods, but maybe in a less fun direction, which
Speaker 2: is diseases that are named after places.
Speaker 1: I like how you said, maybe like there's someone else
Speaker 1: going Yeah.
Speaker 2: Somebody is excited about learning where disease names came from.
Speaker 2: If you saw the title of today's episode and you
Speaker 2: saw the word eponymous and you were expecting food treats
Speaker 2: and now you're disappointed, I'm very sorry. The word eponymous
Speaker 2: is I think most often used to describe something named
Speaker 2: after a person, but it can also describe something named
Speaker 2: after a place or a thing. And this episode is
Speaker 2: also inspired by an experience I had a few years
Speaker 2: ago when I went to visit family and the big,
Speaker 2: big local news story. While I was there was an
Speaker 2: outbreak of Legionnaire's disease connected to walking past a hot
Speaker 2: tub display at affair. I found all of that horrifying
Speaker 2: from a number of directions, and it made me, then,
Speaker 2: of course, want to do an episode on Legionnaire's disease.
Speaker 2: That's a totally normal response to this whole experience. I
Speaker 2: was not able to work that into a whole episode,
Speaker 2: and it just took me a while to kind of think, hey,
Speaker 2: there's a theme here. We are going to really be
Speaker 2: focused on the outbreak that led to these diseases being
Speaker 2: identified and named, so it won't be like a whole
Speaker 2: history of any of these three diseases. Two of the
Speaker 2: diseases we're talking about today are ones that people can
Speaker 2: contract through incredibly casual exposure, like walking past a hot
Speaker 2: tub display. The third requires a lot more pro longed
Speaker 2: direct contact with somebody who is acutely ill, but it
Speaker 2: can really still spread very rapidly in certain conditions. Although
Speaker 2: there will be some experimentation on animals mentioned in this
Speaker 2: episode and one of the most disgusting human experiments that
Speaker 2: I've ever encountered while working on this show. We're gonna
Speaker 2: talk about that just as delicately as possible, but it
Speaker 2: is gross. So first up, as Tracy alluded to, Legionnaire's disease,
Speaker 2: which is caused by Legionella bacteria. Multiple species of Legionella
Speaker 2: bacteria can cause disease, but most outbreaks are connected to
Speaker 2: Legionella numophila. Legionella numophila can actually cause two different diseases,
Speaker 2: Legionnaire's disease and pontiac fever. Both of these can cause
Speaker 2: flu like respiratory symptoms, but pontiac fever is generally milder
Speaker 2: and typically resolves on its own. Legionnaire's disease, on the
Speaker 2: other hand, can cause pneumonia and lead to hospitalization and death.
Speaker 2: It's not fully understood why the same bacteria causes two
Speaker 2: clinically different syndromes, or why outbreaks tend to cause one
Speaker 2: or the other. Legionnaire's disease is named for the American
Speaker 2: Legion convention that was held at the Bellevue Stratford Hotel
Speaker 2: in Philadelphia, Pennsylvania, in nineteen seventy six. I guess we
Speaker 2: could have a semantic argument about whether a convention is
Speaker 2: a place or not. I think it is, at least temporarily.
Speaker 2: The American Legion is a veterans organization that was chartered
Speaker 2: by Congress in nineteen nineteen, focused on service to veterans
Speaker 2: and to their communities. This nineteen seventy six state meeting
Speaker 2: in Philadelphia also ran alongside the US bi centennial, so
Speaker 2: there were a lot of other celebrations and festivities going
Speaker 2: on as well. The American Legion Convention took place from
Speaker 2: July twenty first through twenty fourth, and then on July
Speaker 2: twenty twenty seven, a retired Air Force captain who had
Speaker 2: attended the convention died of an apparent heart attack. Within days,
Speaker 2: other convention attendees had also died after reporting symptoms that
Speaker 2: included fevers, headaches, chest pain, and chest congestion. On the
Speaker 2: afternoon of Friday, July thirtieth, doctor Ernest Campbell of Bloomsburg, Pennsylvania,
Speaker 2: tried to alert the Pennsylvania State Public Health Department that
Speaker 2: some of his patients had become seriously ill after attending
Speaker 2: the convention, but he was told the office had closed
Speaker 2: for the day. Another doctor tried to report a similar
Speaker 2: pattern of illnesses to the health department on Saturday, which
Speaker 2: of course, was also still closed. By the time the
Speaker 2: office reopened on Monday, eighteen people had already died.
Speaker 1: In addition to this delay in starting an investigation into
Speaker 1: what was going on, there were some specifics that made
Speaker 1: it hard to pinpoint where this illness had come come from.
Speaker 1: Medical staff who saw multiple patients all around Pennsylvania made
Speaker 1: a connection to the convention right away, but there were
Speaker 1: also people who got sick who had not gone to
Speaker 1: the convention or even been inside the hotel where it
Speaker 1: was held. One was a bus driver who had driven
Speaker 1: a marching band to Philadelphia for a parade, who had
Speaker 1: spent almost all of his time in Philadelphia on the bus.
Speaker 1: Another person was local to Philadelphia but had not been
Speaker 1: in the hotel for a while, investigators were classifying this
Speaker 1: as two different diseases, legionnaire's disease for convention attendees and
Speaker 1: broad Street pneumonia for everyone else.
Speaker 2: Health authorities in Pennsylvania, once they had gotten those reports,
Speaker 2: contacted the Centers for Disease Control, and the CDC reported
Speaker 2: on the illness in its Morbidity and Mortality Weekly Report
Speaker 2: on Friday, August sixth, the same week that the illnesses
Speaker 2: had first been reported to the Pennsylvania State Public Health Department.
Speaker 2: According to this report, one hundred and fifty two people
Speaker 2: associated with the convention had become ill between July twenty
Speaker 2: second and August third, with most of those illnesses starting
Speaker 2: between July twenty fifth and thirty first. Twenty two of
Speaker 2: those one hundred and fifty two people had died, but
Speaker 2: there didn't seem to be an increase in respiratory diseases
Speaker 2: in Philadelphia more generally, and the illnesses didn't seem to
Speaker 2: have spread between these patients and their family members or
Speaker 2: other close contacts. The CDC included weekly updates in the
Speaker 2: Morbidity and Mortality Weekly Report until September third, at which
Speaker 2: point the outbreak was over. As of August thirty first,
Speaker 2: nineteen seventy six, there had been one hundred seventy nine
Speaker 2: cases and twenty eight deaths, including one hundred forty eight
Speaker 2: people who had been at the convention and thirty one
Speaker 2: who had not, but those had been either in or
Speaker 2: near the hotel at some point. The disease had been
Speaker 2: particularly lethal in people who had other conditions like heart disease, diabetes,
Speaker 2: or cancer, but this report did not include what had
Speaker 2: caused the outbreak because at that point they did not know.
Speaker 2: The CDC Epidemic Intelligence Service and the Pennsylvania Department of
Speaker 2: Health had carried out what was at the time the
Speaker 2: largest infectious disease investigation in CDC history. They had more
Speaker 2: than one hundred and fifty investigators and medical professionals involved.
Speaker 2: They looked for evidence of viruses and bacteria, heavy metals,
Speaker 2: environmental toxins, and other potential causes, without any success. They
Speaker 2: checked seemingly every surface and potential source of contamination at
Speaker 2: the hotel. Because there was this clear connection to an
Speaker 2: American Legion convention, there were even concerns that it had
Speaker 2: been an intentional poisoning carried out by anti war protesters,
Speaker 2: or maybe some kind of biological attack connected to the
Speaker 2: Cold War. Meanwhile, this outbreak had gotten a lot of
Speaker 2: press coverage. There had been an outbreak of swine flu
Speaker 2: at Fort Dix in New Jersey the previous winter, believed
Speaker 2: to be very similar to the virus that had caused
Speaker 2: the nineteen eighteen flu pandemic. This had led to fears
Speaker 2: of an impending pandemic and a huge emergency effort to
Speaker 2: vaccinate people. Although a pandemic had not developed, and various
Speaker 2: issues with this vaccine rollout had led the press to
Speaker 2: call it a fiasco. This had led to heightened anxieties
Speaker 2: around the idea of contagious illness. Also, this was an
Speaker 2: illness that had disproportionately sickened and killed veterans, a lot
Speaker 2: of them retirees during the celebration of the US bicentennial,
Speaker 2: so the whole thing had additional layers of emotional impact,
Speaker 2: like this is right on the heels of the Vietnam War,
Speaker 2: but a lot of the people that were that were
Speaker 2: sickened and killed had served in like World War Two
Speaker 2: and the Korean War, and people rea guarded them with
Speaker 2: like a slightly different nuance than how people were viewing
Speaker 2: the Vietnam War at the time. The fact that so
Speaker 2: many people died so quickly also made this outbreak particularly terrifying.
Speaker 2: On August sixteenth, nineteen seventy six, Time Newsweek and US
Speaker 2: News and World Report all had cover stories about the outbreak,
Speaker 2: and all three of them used the word killer in
Speaker 2: the headline.
Speaker 1: By Christmas of nineteen seventy six, the Bellevue Stratford Hotel
Speaker 1: had closed in the aftermath of the outbreak, and the
Speaker 1: CDC had faced intense criticism for not figuring out the cause.
Speaker 1: This included CDC microbiologist Joseph McDade, who got a lecture
Speaker 1: about it at a Christmas party from a random man
Speaker 1: that he had never met before. McDade worked in the
Speaker 1: lab but was not a decision maker at the CDC,
Speaker 1: but over the week between Christmas and New Years, he
Speaker 1: started re examining slides from his initial work on the case.
Speaker 1: This research had involved exposing guinea pigs to pttential pathogens,
Speaker 1: and investigators had figured out that there was something in
Speaker 1: patient's lung tissue that could make the guinea pigs sick,
Speaker 1: but which then couldn't be transmitted from one guinea pig
Speaker 1: to another.
Speaker 2: What they hadn't been able to do was to isolate
Speaker 2: and identify this pathogen.
Speaker 1: A few things were working against them here. One is
Speaker 1: that the bacteria involved didn't respond to some of the
Speaker 1: stains being used to prepare the microscope slides. Another was
Speaker 1: how the CDC was focusing its efforts. Microbiologists had been
Speaker 1: trying to rule out specific pathogens using preparations developed to
Speaker 1: grow those particular pathogens. Some of these preparations used antibiotics
Speaker 1: to prevent contamination by other bacteria, but those antibiotics were
Speaker 1: also killing the bacteria that caused the outbreak. When McDade
Speaker 1: did new cultures without those antibiotics, he immediately saw clusters
Speaker 1: of bacteria under his microscope. Some additional steps can confirmed
Speaker 1: that this bacterium had caused the outbreak, and it was
Speaker 1: ultimately named lee Jionella numophila.
Speaker 2: The CDC put out a special issue of the Morbidity
Speaker 2: Immortality Weekly Report on January eighteenth, nineteen seventy seven, to
Speaker 2: announce the discovery of this bacterium, and then a peer
Speaker 2: reviewed paper was published in the New England Journal of
Speaker 2: Medicine in December. McDade was a key part of this,
Speaker 2: but he did not do it all alone. He was
Speaker 2: one of six authors listed on the paper, along with
Speaker 2: the laboratory investigation team. The most likely scenario for how
Speaker 2: this bacterium sickened and killed so many people is that
Speaker 2: it had been growing in the Bellevue Stratford Hotel's air
Speaker 2: conditioning system. When a heat wave moved through Philadelphia in
Speaker 2: July of nineteen seventy six, the air conditioning system started
Speaker 2: working harder, and bacteria laden missed from the cooling towers
Speaker 2: made its way into the hotel and to the street
Speaker 2: and sidewalk below, which is why people who had not
Speaker 2: been in the hotel had also gotten sick. Identifying this
Speaker 2: bacterium also allowed investigators to go back and re examine
Speaker 2: other earlier outbreaks, going back to at least nineteen fifty nine.
Speaker 2: One of these outbreaks had taken place in Pontiac, Michigan,
Speaker 2: in nineteen sixty eight. Ironically, this outbreak took place at
Speaker 2: the health department and more than ninety percent of the
Speaker 2: employees had gotten sick. This included some of the CDC
Speaker 2: investigators who arrived to investigate the outbreak. This was a
Speaker 2: much milder illness, though, and everyone recovered, and that's why
Speaker 2: pontiac fever is given a separate name from Legionnaire's disease.
Speaker 2: These outbreaks led to efforts to better coordinate between the
Speaker 2: CDC and local health authorities and more stringent sanitation standards
Speaker 2: for things like air conditioning systems, swimming pools, and hot tubs.
Speaker 2: But there are still disease outbreaks caused by these bacteria,
Speaker 2: including the one in twenty nineteen at the Mountain State
Speaker 2: Fair in Fletcher, North Carolina that was the one that
Speaker 2: inspired this episode. The final report on that outbreak listed
Speaker 2: one hundred and thirty six cases of Legionnaire's disease with
Speaker 2: ninety six hospitalizations and four deaths, as well as one
Speaker 2: case of pontiac fever. Legionella bacteria occur naturally in soil
Speaker 2: and water. So some cases of Legionnaire's disease and pontiac
Speaker 2: fever have also been traced to things like potting soil.
Speaker 2: Let's take a little sponsor break, and then after that,
Speaker 2: we're going to be talking about an illness that's really
Speaker 2: not for the squeamish, and that also is going to
Speaker 2: include the particularly gross research. Next, we're going to talk
Speaker 2: about something that's not as deadly as Legionnaire's disease, but
Speaker 2: it can still cause serious illnesses and death, especially in
Speaker 2: older people, babies, and people that have other health conditions. However,
Speaker 2: it is miserable. It is neurovirus, also called Norwalk virus,
Speaker 2: and it's probably responsible for more than half of food
Speaker 2: borne illnesses worldwide. Neurovirus causes acute gastroenterritis, which is also
Speaker 2: known as stomach flu, although that is a totally different
Speaker 2: virus from influenza. Neurovirus is a highly infectious RNA virus
Speaker 2: that can live on surfaces for up to two weeks,
Speaker 2: and it's not killed by alcohol based hand sanitizer and
Speaker 2: is resistant to a lot of disinfectants, and that's how
Speaker 2: you wind up with stuff like at least two hundred
Speaker 2: and forty two people getting neurovirus after one player was
Speaker 2: sick court side on the first night of a basketball
Speaker 2: tournament and well meaning attendees did the cleanup without informing
Speaker 2: the custodial staff of what had happened. This virus has
Speaker 2: probably been around for centuries, but the first clear to
Speaker 2: description of the illness was by John Zahorski in nineteen
Speaker 2: twenty nine in a paper titled Hyperemesis higamis, or the
Speaker 2: Winter Vomiting Disease. So Horski was a doctor who described
Speaker 2: a cluster of cases he had seen in Saint Louis.
Speaker 2: He differentiated between respiratory diseases that could also cause gastro
Speaker 2: intestinal symptoms and a disease in which the gastro intestinal
Speaker 2: symptoms were the whole thing. He also noted that this
Speaker 2: disease tended to happen in the winter, although norovirus is
Speaker 2: more common in the colder months, outbreaks can happen at
Speaker 2: any time of the year. Norovirus is named for Norwalk, Ohio,
Speaker 2: where an outbreak struck an elementary school in October of
Speaker 2: nineteen sixty eight. A few people became ill on the
Speaker 2: evening of October twenty ninth, but then a lot more
Speaker 2: people got sick on October thirtieth and thirty first, making
Speaker 2: for a terrible Halloween for all of them. This outbreak
Speaker 2: ultimately sickened half the school that also spread to people's
Speaker 2: family members and their close contacts, with a wave of
Speaker 2: secondary cases from November first through third, and then additional
Speaker 2: illnesses continuing until November seventh. According to the CDC report
Speaker 2: on the outbreak, there were ninety nine primary cases and
Speaker 2: one hundred secondary cases. Everybody recovered, though, and nobody had
Speaker 2: to be hospitalized.
Speaker 1: The CDC investigated this outbreak as well. An obvious possible
Speaker 1: source for an outbreak of gastro intestinal illness is food,
Speaker 1: but students who had brought their lunch from home got
Speaker 1: sick at about the same rate as students who got
Speaker 1: their lunch from the school cafeteria. Tests on the food
Speaker 1: and milk that were still on hand in the cafeteria
Speaker 1: did not show any signs of pathogens.
Speaker 2: Another obvious possibility is water. The school had its own
Speaker 2: well rather than being on a municipal water system, and
Speaker 2: that well was routinely chlorinated. It was checked for coliform
Speaker 2: bacteria that did not reveal anything. A miss but it
Speaker 2: also wasn't enough to totally rule it out as a
Speaker 2: possible source of illness, so the school just used bottled
Speaker 2: water until the well was determined to be safe.
Speaker 1: When the CDC issued a report on this outbreak in
Speaker 1: the Morbidity and Mortality Weekly Report on November twenty third,
Speaker 1: no specific cause had been identified, but the overall conclusion
Speaker 1: was that the primary cases had all come from a
Speaker 1: single source, while the secondary cases had spread from person
Speaker 1: to person starting with those primary cases, and the suspected
Speaker 1: cause was a virus.
Speaker 2: The CDC's write up also reflects some expectations around gender
Speaker 2: and parenting. Quote person to person spread was probably responsible
Speaker 2: for the secondary cases, and consequently one might expect a
Speaker 2: significantly higher attack rate in mothers, who have more intimate
Speaker 2: contact with sick children than in fathers, and a higher
Speaker 2: attack rate in larger families five or more members than
Speaker 2: in small doller families. Although the attack rate in mothers
Speaker 2: thirty seven percent was higher than in father's twenty two percent,
Speaker 2: this difference was not statistically significant. Furthermore, attack rates in
Speaker 2: large and small families were similar. Although researchers could not
Speaker 2: identify the pathogen right away, they did want to confirm
Speaker 2: whether there was an infectious agent at work that was
Speaker 2: shed by sick people and could infect others. This involved
Speaker 2: collecting and preparing what we are just going to call
Speaker 2: the inoculum, which was then given to volunteer test subjects.
Speaker 1: This was not a new idea. The nineteen seventy one
Speaker 1: paper detailing this research cited three prior studies from the
Speaker 1: nineteen forties and fifties that had similarly showed that it
Speaker 1: was possible to transmit non bacterial gastroenteritis this way. Different
Speaker 1: versions of the inoculum were made from samples collected during
Speaker 1: four outbreaks of gastro intestinal illness at the elementary school
Speaker 1: in Norwalco, Ohio, aboard the US Navy ship Shenandoah while
Speaker 1: it was in the Caribbean, and in New Britain, Connecticut,
Speaker 1: and Bethesda, Maryland. The inoculum was presumed to contain something
Speaker 1: non bacterial that was going to cause gastrointestinal illnesses, but
Speaker 1: it also went through a bunch of cultures and safety
Speaker 1: tests to try to make sure that it did not
Speaker 1: contain any other known pathogen that could cause problems or
Speaker 1: other illnesses. Two groups of participants were part of this study.
Speaker 1: Some were men who were incarcerated at the Maryland House
Speaker 1: of Correction in Jessup, Maryland, and others were from the
Speaker 1: Clinical center of the National Institutes of Health. The paper
Speaker 1: detailing this work described all of these participants as volunteers
Speaker 1: who all gave informed consent before participating, but there are
Speaker 1: a lot of caveats around the idea of volunteering for
Speaker 1: medical research in the context of being incarcerated. The Maryland
Speaker 1: House of Correction was also vote notorious for violence and
Speaker 1: harsh treatment of the people incarcerated there.
Speaker 2: Participants were given a complete physical exam, including lots of
Speaker 2: lab work and chest X rays, to confirm that they
Speaker 2: were in good health before being given the inoculum. They
Speaker 2: were also treated with gamma globulin injections to protect them
Speaker 2: in case there was some kind of hepatitis contamination in
Speaker 2: the inoculum that would not have shown up on tests.
Speaker 2: Participants at the prison were isolated in the prison's hospital ward,
Speaker 2: and participants in the clinical center of the nih were
Speaker 2: placed in isolation rooms there.
Speaker 1: The only inoculum that produced illness in this experiment was
Speaker 1: the one that had been prepared from samples collected in
Speaker 1: Norwalk Ohio. Of the three volunteers who received this inoculum,
Speaker 1: two became ill. Then their samples were used to prepare
Speaker 1: additional inoculum, which was administered to additional test subjects. Seven
Speaker 1: of those nine people also became ill. When another round
Speaker 1: of innoculum was prepared from these patients, only one of
Speaker 1: the fore men who received it became ill.
Speaker 2: A paper detailing this research has been described as a
Speaker 2: landmark article in the study of viral gastroenteritis, and it
Speaker 2: created a pretty thorough picture of how this disease could
Speaker 2: spread and what symptoms it could cause, but it still
Speaker 2: was not clear what the actual pathogen was. The paper
Speaker 2: uses the term non bacterial, and some researchers thought the
Speaker 2: illness must be caused by a virus, but others thought
Speaker 2: a virus was unlikely because so many other acute gastro
Speaker 2: intestinal illnesses were caused by known bacteria, including E. Coli
Speaker 2: and salmonilla. The only thing that had been mostly ruled
Speaker 2: out was toxins, because it seemed unlikely that a toxin
Speaker 2: could progressively pass through multiple people's digestive systems to then
Speaker 2: sicken other people. Researchers using immuno electronic roscopy finally got
Speaker 2: a look at a particle measuring twenty seven nanometers in
Speaker 2: samples collected in Norwalk in nineteen seventy two. This made
Speaker 2: neurovirus the first viral gastroenteritis to be conclusively identified, and
Speaker 2: within a few years it was being connected to a
Speaker 2: lot of illnesses. One paper published in nineteen seventy nine
Speaker 2: suggested that a third of the acute gastroenteritis outbreaks that
Speaker 2: didn't have a known cause had likely been caused by
Speaker 2: Norwalk like viruses. Technological developments later in the nineteen seventies
Speaker 2: and into the nineteen eighties allowed researchers to study the
Speaker 2: virus further and some more easily detect and identify it
Speaker 2: in samples during outbreaks, and this also led to efforts
Speaker 2: to identify other viruses that could cause similar illnesses, including rotavirus,
Speaker 2: enteric dentovirus, and astrovirus. Neurovirus's whole genome was sequenced in
Speaker 2: the nineteen nineties, and today it is described as part
Speaker 2: of the Calisaveridae family of viruses. Studying neurovirus continues to
Speaker 2: be challenging, though it's only been within the last few
Speaker 2: years that researchers have found animal species that could potentially
Speaker 2: work as a model for human beings in terms of neurovirus,
Speaker 2: and it has also only been recently that researchers have
Speaker 2: figured out how to cultivate the virus in vitro. These
Speaker 2: are also some of the reasons why there's not yet
Speaker 2: a vaccine for neurovirus. As we said earlier, it can
Speaker 2: be deadly in some people, but for most people it's
Speaker 2: just an extremely unpleasant inconvenience that would be really nice
Speaker 2: to avoid. According to a paper published in the Journal
Speaker 2: of Infectious Diseases in twenty twenty, neurovirus outbreaks in the
Speaker 2: United States costs an estimated seven point six million dollars
Speaker 2: in direct medical costs annually, and then another one hundred
Speaker 2: and sixty five million dollars in loss productivity. Also just
Speaker 2: it's real unpleasant thing to have to go through beyond
Speaker 2: those economic numbers. In addition to all the difficulties in
Speaker 2: studying the virus itself, there are also multiple strains of
Speaker 2: it that shift very rapidly, and that makes the effort
Speaker 2: to create a vaccine even more complicated.
Speaker 1: So there are going to continue to be neurovirus outbreaks
Speaker 1: all around the world for the foreseeable future. They're particularly
Speaker 1: common in places like hospitals, schools, and restaurants. Gastro Intestinal illnesses,
Speaker 1: including neurovirus, are so common on cruise ships that the
Speaker 1: Centers for Disease Control has a whole vessel sanitation program
Speaker 1: to try to prevent and track outbreaks on board. Some
Speaker 1: outbreaks are almost counterintuitive, like there have been a number
Speaker 1: of outbreaks on long distance hiking trails like the Pacific
Speaker 1: Crest Trail and the Appalachian Trail, which are exacerbated by
Speaker 1: people using common latrines and shelters and often relying on
Speaker 1: hand sanitizer rather than soap and water. Let's take a
Speaker 1: quick sponsor break and then talk about on illness that's
Speaker 1: a lot dead than neurovirus, but also not nearly as
Speaker 1: easy to spread.
Speaker 2: The last disease we're going to talk about is one
Speaker 2: that is surrounded by a lot of stigma and fear,
Speaker 2: which is ebola virus disease. Ebolavirus disease is a hemorrhagic
Speaker 2: disease with a high mortality rate. The World Health Organization
Speaker 2: estimates the average at fifty percent, although different species of
Speaker 2: ebolavirus can have very different mortality rates, some of them
Speaker 2: much higher than that. People who survive ebola infection can
Speaker 2: also have long term physical and mental health effects afterward.
Speaker 2: All of this is genuinely scary, which has really contributed
Speaker 2: to that stigma in places that are affected by this disease.
Speaker 2: This includes people who have survived ebola who can continue
Speaker 2: to face stigma and ostrasis after recovering. Since Ibola is
Speaker 2: also found almost entirely in Central and Western Africa, there's
Speaker 2: also a lot of stigma and misinformation about it in
Speaker 2: other parts of the world, based on people's preconceptions and
Speaker 2: biases rather than any actual experience or knowledge about the disease.
Speaker 1: There were two concurrent outbreaks of a Bowla virus disease
Speaker 1: in nineteen seventy six, although at the time it was
Speaker 1: not known that these were caused by two different species
Speaker 1: of the virus, and it seemed like they were probably related.
Speaker 1: One started in the Southern Sudan Autonomous Region, which was
Speaker 1: then part of Sudan but is South Sudan's today. The
Speaker 1: other was in what's now the Democratic Republic of the Congo,
Speaker 1: which was then known as Zaire.
Speaker 2: The first cases in the first known outbreak of ebola
Speaker 2: were reported in workers at a cotton factory in Nzara,
Speaker 2: which is in what's now South Sudan. This is a
Speaker 2: town roughly twenty five kilometers nor the east of the
Speaker 2: border with the DRC. The cotton factory was part of
Speaker 2: a large agricultural cooperative, which was in Zara's primary employer.
Speaker 2: About four hundred and fifty people worked at the cotton factory,
Speaker 2: with about two thousand people employed at the agricultural collective overall.
Speaker 2: The first illnesses were reported in June and July of
Speaker 2: nineteen seventy six in men who worked as storekeepers at
Speaker 2: the cotton factory. These men were connected only through their
Speaker 2: jobs and didn't have any common contacts outside of work.
Speaker 2: The first to become ill eventually went to the hospital
Speaker 2: and died there on July sixth. His brother had taken
Speaker 2: care of him at home and got sick as well,
Speaker 2: but he recovered. The second man to get sick also
Speaker 2: died in the hospital on July fourteenth. His wife had
Speaker 2: taken care of him at the beginning of his illness,
Speaker 2: and she died at their home on July nineteenth. The
Speaker 2: third reported illness was in a man who worked in
Speaker 2: a cloth roam adjacent to the store who got sick
Speaker 2: in mid July, and he also had no other contacts
Speaker 2: with these other two men outside of work, but he
Speaker 2: had a much more active social life than either of
Speaker 2: them did. He had lots of friends, and his friends
Speaker 2: also had lots of friends, and this illness really quickly
Speaker 2: spread among all these friends and acquaintances as people looked
Speaker 2: after each other when they were sick and also just
Speaker 2: visited and checked in on one another. This included the
Speaker 2: virus being introduced into other areas when people traveled, often
Speaker 2: before they realized that they were sick.
Speaker 1: Emola spreads through contact with blood and other bodily fluids,
Speaker 1: and it also causes things like vomiting and hemorrhaging, so
Speaker 1: it can spread easily between patients and the people taking
Speaker 1: care of them, especially if those caregivers don't have access
Speaker 1: to things like protective equipment and disinfectants. This pattern of
Speaker 1: spread also meant that the outbreak in them Tizara eventually
Speaker 1: ended as people started avoiding one another out of fear
Speaker 1: of the illness, and the remaining patients and their caregivers
Speaker 1: either recovered or died. The last reported infection in Nazara
Speaker 1: was on October twenty seventh, nineteen seventy six, and there
Speaker 1: were sixty seven total cases there. By the end of
Speaker 1: this outbreak there thirty seven percent of the workers in
Speaker 1: the cloth factory had been infected. It's likely that the
Speaker 1: initial source of the infection was bats that were living
Speaker 1: in the roof space of the factory, or possibly rats
Speaker 1: that had contracted it from the bats. But on August seventh,
Speaker 1: abola had also been introduced to the town of Meridi,
Speaker 1: about one hundred and fifty kilometers away, when a patient
Speaker 1: was admitted to the hospital there. This patient had been
Speaker 1: close friends with the third worker from the Nazara cotton
Speaker 1: factory who became ill. A second patient from Nazara, who
Speaker 1: was a nurse, was also admitted to the Meridi hospital
Speaker 1: on Allfae August twenty ninth.
Speaker 2: And as this illness started to spread at the hospital,
Speaker 2: conditions there quickly broke down. This was a teaching hospital
Speaker 2: and a lot of the people who got sick were
Speaker 2: nurses and nursing students. By the end of the outbreak
Speaker 2: in Mariti, ninety three of two hundred and thirteen cases
Speaker 2: had been contracted at the hospital. With seventy two of
Speaker 2: those cases, or about seventy seven percent, being among hospital staff.
Speaker 2: This included the doctor in charge and about forty percent
Speaker 2: of the nursing staff, about half of whom died. Understandably,
Speaker 2: patients and staff alike started to be afraid to go
Speaker 2: to the hospital, and that meant the disease continued to
Speaker 2: spread out in the community as people were cared for
Speaker 2: by friends or relatives instead, as they became more and
Speaker 2: more ill, and people with other illnesses and conditions weren't
Speaker 2: able to get the care that they needed because of
Speaker 2: what was happening at the hospital. This disease he also
Speaker 2: spread in the community as people prepared their loved ones
Speaker 2: bodies for their funerals.
Speaker 1: As the disease was starting to spread in the hospital
Speaker 1: at Meridi, another outbreak began in the Yambuku Mission Hospital
Speaker 1: in what's now the Democratic Republic of the Congo. The
Speaker 1: headmaster of the Yumbuku Mission School was admitted to the
Speaker 1: hospital on August twenty sixth with what was believed to
Speaker 1: be a relapse of malaria. He had just returned from
Speaker 1: a two week trip to the area near the border
Speaker 1: with Sudan. He was treated with anti malarial medications by injection,
Speaker 1: and he was discharged on September first, but he returned
Speaker 1: on September fifth after developing a hemorrhagic illness, and he
Speaker 1: died the following day. Another man, whose identity is not known,
Speaker 1: had also been admitted to the hospital on August twenty eighth.
Speaker 1: He was experiencing nosebleeds, dysentery, and fever. He left the
Speaker 1: hospital two days later, even though he was serious ill
Speaker 1: and what happened to him after that is not known.
Speaker 1: Some sources conclude that the headmaster was the index patient
Speaker 1: in this outbreak, while others conclude that it was that
Speaker 1: unknown other patient. It is possible that the headmaster contracted
Speaker 1: abola during his treatment for malaria through a needle or
Speaker 1: a syringe that had been used on the other patient.
Speaker 2: Injections using contaminated needles and syringes became a major source
Speaker 2: of the spread of illness in this outbreak. At the time,
Speaker 2: it was a common practice at the hospital to administer
Speaker 2: a lot of medicines and supplements by injection, including things
Speaker 2: like prenatal vitamins. Some of this was cultural. People generally
Speaker 2: believed that medicines delivered by injection were more powerful and
Speaker 2: worked better than ones that were taken orally, so nurses
Speaker 2: administered more injections than they would have in other contexts.
Speaker 2: This was an impoverished area without a lot of resources,
Speaker 2: including a limited supply of needles and syringes. These were
Speaker 2: rinsed with sterile water between patients, and they were boiled
Speaker 2: at the end of the day, but neither of those
Speaker 2: steps was enough to effectively sterilize them. Roughly a quarter
Speaker 2: of the ebola patients at this hospital had no risk
Speaker 2: factors for the disease other than the injections that they
Speaker 2: received there. As had happened in Mariti, the disease also
Speaker 2: spread from patients to their direct caregivers at the hospital. Ultimately,
Speaker 2: thirteen of the seventeen staff at Yambuku Mission Hospital became ill,
Speaker 2: and eleven of them died. People in Yambuku also contracted
Speaker 2: the illness while preparing people's bodies for their funerals. This
Speaker 2: included the headmaster's mother, wife, mother in law, sister in law,
Speaker 2: and other loved ones. The disease also spread from Yambuku
Speaker 2: to the capital city of Kinshasa. In September of nineteen
Speaker 2: seventy six, doctor Gooi Mishola, who was the district's chief
Speaker 2: medical officer, visited Yambuku and wrote the first clinical description
Speaker 2: of this disease that with description was sent to health
Speaker 2: officials in Kinshase. On September twenty eighth, Belgian physician Jacques
Speaker 2: Corteat took a blood sample from a nun at a
Speaker 2: hospital in Kinshase. He sent this sample to the Institute
Speaker 2: of Tropical Medicine and Antwerp, Belgium, where it was analyzed
Speaker 2: in the microbiology department electron Micross because Vin Jakub spotted
Speaker 2: a Marburg like virus in this sample, and then the
Speaker 2: institute notified the World Health Organization. Marburg virus is named
Speaker 2: for Marburg, Germany, which was the site of an outbreak
Speaker 2: of another hemorrhagic fever in nineteen sixty seven. That nineteen
Speaker 2: sixty seven outbreak also involved Frankfurt, Germany in Belgrade, Serbia,
Speaker 2: and it was connected to contact with monkeys that were
Speaker 2: used in laboratory research.
Speaker 1: Officials from the World Health Organization arrived in Zayu on
Speaker 1: October nineteenth and in Sudan on October twenty ninth, and
Speaker 1: in both places went through similar efforts to work with
Speaker 1: local health officials and medical and nursing staff to investigate
Speaker 1: and contain these outbreaks. This included distributing personal protective equipment
Speaker 1: like gowns, masks, and gloves, and teaching staff how to
Speaker 1: use them Safely. Donning and doffing this kind of protective
Speaker 1: equipment without contaminating anything is a whole process. They also
Speaker 1: taught nursing staff how to thoroughly sterilize needles and other instruments,
Speaker 1: and worked with local leaders and chieftains to identify cases and,
Speaker 1: whenever possible, bring patients to isolation units at a hospital.
Speaker 1: An isolation bard had been built in Mariti just before
Speaker 1: the World Health Organization arrived. Since there was no known
Speaker 1: treatment for this illness, the World Health Organization also collected
Speaker 1: plasma from people who had recovered to see if it
Speaker 1: could be used for therapeutic purposes. This process took time, though,
Speaker 1: since they also needed to develop tests to confirm that
Speaker 1: this plasma didn't contain any active virus. Direct patient care
Speaker 1: was handled by healthcare workers from the local area, while
Speaker 1: the World Health Organization managed things like disease surveillance, tracking,
Speaker 1: education and support. Samples were also sent to facilities that
Speaker 1: had the ability to contain such a dangerous pathogen, including
Speaker 1: the Centers for Disease Control in Atlanta and Porting Down
Speaker 1: in the UK. The virus was eventually determined to be
Speaker 1: in the same family as Marbourg virus. The species of
Speaker 1: a bolovirus that were involved in these two outbreaks are
Speaker 1: now known as Sudan a bolavirus and Zayre a bolavirus.
Speaker 2: By the end of these outbreaks, three hundred eighty one
Speaker 2: people had contracted the disease in what's now the Democratic
Speaker 2: Republic of the Congo, and two hundred and eighty of
Speaker 2: them had died. In Sudan, there were two hundred and
Speaker 2: eighty four cases and one hundred and fifty one deaths.
Speaker 2: There was also one smaller outbreak in this same part
Speaker 2: of South Sudan in nineteen seventy nine, but then after
Speaker 2: that there was really no known ebola activity until nineteen
Speaker 2: ninety four. The nineteen ninety four outbreak kind of revived
Speaker 2: scientific and medical interest in studying the disease. The largest
Speaker 2: ebola epidemic in history took place between twenty fourteen and
Speaker 2: twenty sixteen, when the disease was introduced into more densely
Speaker 2: populated areas in western Africa that had no prior experience
Speaker 2: with it.
Speaker 1: There were more than twenty eight thousand suspected and probable
Speaker 1: cases and more than eleven thousand deaths during this outbreak.
Speaker 1: It was confirmed that a Bola virus can be transmitted
Speaker 1: sexually as well as through direct contact with blood and
Speaker 1: other bodily fluids.
Speaker 2: It's suspected that bats are the natural carrier of this virus,
Speaker 2: although other animals can carry it as well, and in
Speaker 2: addition to the types of transmission that we've talked about
Speaker 2: in this episode, it can also be transmitted when people
Speaker 2: have contact with animals, including when hunting and when butchering
Speaker 2: animals for their meat. Today, a bolavirus disease is treated
Speaker 2: with monoclonal antibodies and supportive care, and there are two
Speaker 2: licensed vaccines for zayre ebolavirus. Carl Johnson, who was part
Speaker 2: of the international commission that formed to investigate and worked
Speaker 2: to control this outbreak, suggested the name of Bolah for
Speaker 2: a river in the Northern Democratic Republic of the Congo. Locally,
Speaker 2: this river is more commonly known by its Bondi name
Speaker 2: of Lake Bala. This name was accepted in nineteen seventy
Speaker 2: seven Johnson reportedly suggested this name because he wanted to
Speaker 2: avoid bringing additional stigma to any of the villages, towns,
Speaker 2: or cities where this outbreak had taken place, and this
Speaker 2: is part of the thought process for how diseases are
Speaker 2: named today. In twenty fifteen, the World Health Organization released
Speaker 2: updated best practices for naming diseases and they specifically discouraged
Speaker 2: the use of geographic locations as well as people's names, industries, foods,
Speaker 2: and animals. And this is because these kinds of names
Speaker 2: for diseases can contribute to a lot of stigma and
Speaker 2: other unnecessary negative effects, including misinformation like monkey pox, which
Speaker 2: has been renamed empos doesn't have anything to do with
Speaker 2: monkeys other than that it had been identified in work
Speaker 2: that involved lab monkeys. The word monkey is connected to
Speaker 2: racist stigma, and then people were sort of folding that
Speaker 2: into their discussions of the disease. And we also all
Speaker 2: just lived through something like this at the start of
Speaker 2: the COVID nineteen pandemic, when people, mostly outside of the
Speaker 2: medical field, used the fact that it was first reported
Speaker 2: in China to stoke a lot of anti Asian racism.
Speaker 2: So there are a lot of these names that are
Speaker 2: still in use, but the best practice now is to
Speaker 2: just name things descriptions of what the illness is, rather
Speaker 2: than connecting it to like a place or a person,
Speaker 2: or an industry or anything like that.
Speaker 1: I have thoughts on this. We'll discuss that.
Speaker 2: Sure, Sure we may have another one of these episodes
Speaker 2: at some point in the future, because I found it interesting.
Speaker 1: Do you have listener mail for us?
Speaker 2: Yes?
Speaker 1: I have email.
Speaker 2: This email is from Carolyn, who wrote about Icelandic volcanoes
Speaker 2: and Norwegian corvids. Carolyn wrote, Hello, Tracy and Holly. Huge
Speaker 2: fan and second time emailer. I finished John Ben and
Speaker 2: the Lucky Fisher episodes yesterday on my commute and had
Speaker 2: to write in again. No pronunciation corrections this time. Carolyn
Speaker 2: is one of the folks who wrote in about how
Speaker 2: to say decalb.
Speaker 1: It's so hard to see it.
Speaker 2: I can't. Yeah, I have a hard time for me too. First,
Speaker 2: I also love and have already visited this year, so
Speaker 2: I won't be joining you. I do have a suggestion
Speaker 2: for another country for a future stuff you miss in
Speaker 2: history class road trip, But more of that in a minute.
Speaker 2: If you haven't already been to the Snifelessness Peninsula in Iceland.
Speaker 2: You may want to go there. I've attached two of
Speaker 2: my favorite seal pictures from our trip there earlier this year.
Speaker 2: I was so excited to hear you talk about the
Speaker 2: Locky Fissure because that was my very first introduction to
Speaker 2: Iceland before my husband and I went for the first
Speaker 2: time just before shut down in March twenty twenty. I
Speaker 2: read Island on Fire by Alexandra Vitz to do some
Speaker 2: quote light geology reading, history reading before arriving. I don't
Speaker 2: know if you use this book in your research for
Speaker 2: the episode, but I highly recommend it. I was fortunate
Speaker 2: to see the chapel dedicated to Jan Steinerson on another trip.
Speaker 2: It's small but cool, but it wasn't open when we stopped.
Speaker 2: I was also so grateful to meet you both in
Speaker 2: person at the recent live episode of and Indie, and
Speaker 2: Holly's mention of crow love reminded me that I hadn't
Speaker 2: yet sent the pictures of Norwegian hooded crows. I think
Speaker 2: they look like they're wearing fluffy vests. My husband is
Speaker 2: Norwegian and I have a lot of topic suggestions for you,
Speaker 2: and wonder if you've considered doing a trip there. It's
Speaker 2: really beautiful and full of history that definitely has not
Speaker 2: made it into many American history books. Carolyn then follows
Speaker 2: with some topic suggestions and says, since I sent pictures
Speaker 2: of my dog Penny, she loves kisses Holly and my
Speaker 2: granddog and kitties last time, my pet taxes some pictures
Speaker 2: of the beautiful hooded crows and icelandic seals, I hope
Speaker 2: you enjoy best. Carolyn, thank you so much for this email.
Speaker 1: Carolyn.
Speaker 2: I did not use that book as part of the
Speaker 2: research for the Locky Fissier eruption episode, but I did
Speaker 2: have a paper by that author that was part of it.
Speaker 2: There were just too many possible resources to use to
Speaker 2: be able to go through all of them. And man,
Speaker 2: these birds are definitely beautiful, and you're right they look
Speaker 2: like they have little white vests on this is I
Speaker 2: don't think this is a place that we visited when
Speaker 2: we were in Iceland last time, and I have not
Speaker 2: looked at a map to see if it is in
Speaker 2: the vicinity of where we will be in November. We
Speaker 2: have mentioned the trip we're taking to Iceland in November
Speaker 2: a couple of times recently. At last check that was
Speaker 2: sold out, but there is a waiting list, and if
Speaker 2: you're curious and maybe you want to see if you
Speaker 2: can get on that waiting list, it is at Defined
Speaker 2: Destinations dot com. So thank you again for sending these
Speaker 2: great pictures in this email, Carolyn. If you would like
Speaker 2: to write to us about this or any other podcast,
Speaker 2: or at History Podcast at iHeartRadio dot com, and you
Speaker 2: can subscribe to the show on the iHeartRadio app or
Speaker 2: wherever else you would like to get your podcasts. Stuff
Speaker 2: you Missed in History Class is a production of iHeartRadio.
Speaker 2: For more podcasts from iHeartRadio, visit the iHeartRadio app, Apple Podcasts,
Speaker 2: or wherever you listen to your favorite shows.